Ethical Considerations for Nurses: Euthanasia in Ontario, Canada

This discussion paper delves into the ethical complexities of euthanasia within the nursing profession in Ontario, Canada. It examines the legal framework, particularly the removal of sections from the Canadian constitution that previously prohibited euthanasia, and its impact on healthcare providers. The paper explores core ethical principles such as autonomy, beneficence, justice, and non-maleficence, analyzing their application in end-of-life care decisions. It highlights the importance of compassion, respect, and the nurse's role in supporting patients and families. The paper also addresses the challenges nurses face in balancing patient wishes with legal and moral obligations, emphasizing the need for careful consideration of each case and adherence to ethical guidelines. The discussion underscores the significance of providing dignified and peaceful end-of-life care while respecting patient rights and autonomy.

Running Head: Euthanasia Ethical Issues in Ontario Canada. 1
Discussion paper
NURSING ETHICAL ISSUES IN EUTHANASIA
Name
Institution

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Introduction
Euthanasia is a medical practice where medics are legally allowed by the policies of a given
nation to assist patients who are in severe pain to die. Euthanasia is practiced with the consent of
the patient who has no signs of recovery since he or she may be suffering from an incurable
diseases and experiencing a lot of pain at the same time. Since it is the role of the nurses and
doctors to work around the clock in relieving patients from pain, euthanasia is then practiced as a
way of relieving patients with deadly infections from severe pain. Drugs can be administered and
the patient is allowed to take at their own time of choice.
Thesis: This paper focuses on the ethical issues of nurses in assisting patient to die due to
incurable diseases and severe pain. The policies of Ontario Canada are particularly paid attention
to in the administration of euthanasia.
Background
Euthanasia has remained prohibited in the entire Canada until February 2015 when two major
sections of the constitution were removed on the basis of obedience to the last wishes of an
individual. Section 14 stated that no individual should request to be inflicted with death and
section 241(b) states that any person that assists another to commit suicide commits a crime
(Cuman, & Gastmans, 2017). These two sections of the Canadian constitution were designed to
protect people who are vulnerable from being lured to commit suicide when they are at their
moments of weakness. The decision made has then brought a revolution in the Canadian medical
sector since the nurses and other physicians now have got a legal right to execute euthanasia
upon declaration that a patient cannot recover, and she or he is in severe pain and at the same

Running Head: Euthanasia Ethical Issues in Ontario Canada. 3
time has requested to have their life terminated. The nurses who have always remained torn apart
between following a patients wish and adherence to the constitution have now got an opportunity
to assist patients who are seeking to end their suffering (Ricou & Wainwright, 2018). The
process is not only dying but dying peacefully and decently in a bid to uphold dignity until the
last minute of an individual’s life.
Ethical issues in euthanasia
Autonomous decision
Autonomy is the process of making personal informed decisions that directly contribute ones
welfare either economically, socially, physically or psychologically. In the health setting and
particularly euthanasia, patients are allowed to make decisions concerning their current situations
(Shekhawat, Kanchan, Setia, Atreya & Krishan, 2018). Some of them do not generally speak it
out directly but mostly they make wishes such as “I wish I will die now”, “God take my life or
take me home” etc. these wishes are normal when an individual is in severe pain even in
instances where diseases involved are not terminal illnesses. The nurses and medics should then
be very careful not to assist patients who are suffering from curable diseases to die. The law in
Ontario is very clear under the circumstances where euthanasia can be executed. This means if a
patient is not terminally ill, not in severe pain and has not made any wish to die then the need to
die should not be inculcated unto them. The nurses in Ontario Canada are prohibited from
soothing a patient to committing suicide. Though the sections of the constitution that disregarded
euthanasia have been seceded, the decision of a patient is upheld and the nurses are bound to
respecting it. The family members in some instances due to the burden of healthcare may decide
to seek for interventions to terminate a patient’s life with his or her consent. The medics in such

Running Head: Euthanasia Ethical Issues in Ontario Canada. 4
cases should not adhere to their suggestions since the reasons may not be clearly known and the
patients are protected from such risks (Caputo, 2015). Family members may be on the contrary
regarding the patient’s decision but the law upholds it and in cases where relatives may sue a
medic the law clearly defends them on the basis of autonomy.
Beneficence
This means doing good to the patients in accordance to the moral obligation. The definition of
beneficence is practicing acts of charity, mercy and kindness regardless of the person the
healthcare practitioner is attending to. The healthcare providers in the practice of euthanasia has
got a moral obligation of doing right rather than following tides (Hosseinzadeh, & Rafiei,
2019)which makes the practice wrong and unacceptable. The nurses are bound and obliged to
always and without favorism or exception to do anything to favor the well being of the patient. In
an agonizing situation where the patient is in deep pain and expressing the wish to die as a way
to be relieved from the oppression of the illness, the health care professionals are expected to do
anything possible to favor the patient. Euthanasia is then administered in such instances to ensure
the patient wellbeing is looked into (De Bal, De Casterlé & Gastmans, 2017). the health care
practitioners who are passionate about their job are expected to show very high standards of
professionalism to advocate for the good of the patients rather than merely considering
themselves and their general likes and feelings. The principle of beneficence is at all times
supposed to work in a manner that it embraces humanism. Since all individuals are entitled
immutable rights to life and liberty euthanasia is practised so as to respect these rights which are
very fundamental for the wellbeing of an individual. In consideration to the state a patient may
be in, the most appropriate action is undertaken with the aim of ensuring that suffering is

Running Head: Euthanasia Ethical Issues in Ontario Canada. 5
stopped. Euthanasia in Ontario Canada remains principled to be undertaken with the consent of
the patient so as to reduce harm that the patient might be going through as a result of the illness
(Minerva, & Sandberg, 2017). Beneficence generally strives to provision of the best care while
embracing. This means nothing harmful is being done to the patient but all things are done to
favor him or her.
Justice
Justice as an ethic in euthanasia means being impartial and fair. The medical personnel should
make decisions that are impartial regardless of the resources available, economic status of the
patient, the ethnic originality of the patient or the sexual orientation of the specific individual
(Shibata, 2017). The Ontarian policies outline that justice must be put into consideration before
euthanasia is administered to any patient even if they are wishing to die as a result of the
torments they are going through. The medical practitioners are therefore expected to determine
whether there are any possibilities of an individual to recover from the illness. They are also
bound to listen to the patient’s views and support him or her in making a suitable decision
concerning their fate and health. In addition to this the nurses are supposed to determine any
significant improvement or deteriorations in the health of the patient in a bid to put their hand in
the decision that the patient is going to make (Muller, Kimsma & van der Wal, 2018).The family
view is also adhered to and in cases where family members are for the idea of euthanasia and the
patient is against then the medical personnel will advocate for the patients decision to have its
way. In cases where there are no signs of recovery and the patient is determined to die then the
nurses will help the patient to die in dignity and peace.

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Non maleficence
This is a rule that governs nurses so that they do not harm patients intentionally. The nurses then
must provide standard care which should be able to avoid risks or be in a position to minimize.
The medical competencies are carefully paid attention to and negligence of duties is such as
attending to the patients are minimized (Requena, 2016). In Ontario Canada, nurses are allowed
to inflict the list possible harm to the patients so as to be able to reach a beneficial medical
outcome. The Hippocratic Oath presents nonmaleleficence as “medical practitioners do no harm
to the relevant clients who are the patients under their care.” This therefore means the ratio
between the risk and the benefit has to be determined before a solution is rendered to a patient’s
problem. The decision to be made in such an instance thus must favor the patient and advocate
for his or her general well being. The harm that will be inflicted and its effects are then
considered as part of the ethical decision that will be made. At the same time the patient is made
aware of the intended steps to be taken for his or her welfare (Forbes, 2018). The medics are
supposed to communicate to the patient effectively the plan to recovery. Short and long term
harm aimed at saving the life of the patient is considered useful. Euthanasia too falls in this
category since the patient’s agony is brought to an end in a manner that dignity of the patient and
peaceful death is induced. In response to the ethical issues surrounding euthanasia, nurses are
expected to administer the best form of death in case the final decision made is to induce death to
stop suffering.

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Compassion and respect
The nurses are bound by the ethic of respect and compassion in Ontario. This is evident in cases
where they are supposed to adhere to the demands of the family members concerning the well
being of their relatives (Keown, 2016). No nurse is permitted to violate the demands of the
family concerning the health of the patient they are taking care of. If for instance a family does
not wish to allow their sick person to be hospitalized then alternatives is granted and if they insist
that they will not allow any of the alternatives then they are allowed to do what pleases them.
The many issues that face families make them to try and push nurses to doo what pleases them.
This means the medics should be very careful to know the cause of the push and ensure that all
actions they take are on the best interest of the patient and not the family. This is because some
can be acting in that manner due to financial constraints attached to taking care of a sick person.
Some also may act on the basis of family wrangles an aspect that makes them to push for
euthanasia so as to overcome the pressure or the opposition coming from the sick person. Valid
reasons have to be established before a patient is assisted to commit suicide because euthanasia
is attached to well articulate strict rules which are bound to be obeyed by all the individuals
working in the health sector. Though support should be provided to the patients to die in dignity,
it is clear that good establishment should be done before making the decision (Goldstein, Cohen,
Arnold, Goy, Arons, & Ganzini, 2016). The patient should also not be soothed to commit suicide and
should be given adequate time to decide whether or not to go for euthanasia. The medics are
supposed at this juncture to provide the necessary support without intruding the privacy of the
patient. The nurses at the same time should stand up for their own rights so as to limit the
number of individuals who treat them disrespectfully. Consultations should be done amongst the
care giving team of nurses to determine whether an individual who is advocating for his or her

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death through euthanasia is worth to be accorded the service (Weikart, 2016). If found eligible
according to the established principles then euthanasia executed at the time which is suitable for
the patient.
Confidentiality
The nurses and other medical practitioners are supposed to keep the information shared by the
patients in their custody. This means they should not share the information to any other persons
without the approval of the legal owner of the information. In Ontario Canada patients at all
times are issued with written and clear notifications which show how their health records are
used in instances where the information has to be disclosed to a third party (Sullivan, 2019). In
euthanasia too, confidentiality is practiced since some patients do not wish their deal with the
medics to be disclosed even to the family. For example a patient in pain and on life support
machines will wish that the machines are withdrawn so as to allow him or her die (Caron, 2014).
The doctor after observing that there are no possibilities of recovery will then take an initiative
once they are in agreement with the patient to withdraw the life support hence allowing nature to
take its course. This information is very vital and the medic involved is not expected whatsoever
to share this information because he may be termed as a murderer or the dead person may be
termed a suicidal. Confidentiality then is only broken under one condition and that is the patient
has allowed it to happen for reasons that are known to him or her. Sharing of the information
without the patients consent is therefore prohibited and any individual who breaks this law is
held accountable. In cases where euthanasia has to be undertaken as the only resolution to relieve
a patient from extreme pain then appropriate rules are keenly looked into to avoid any
misinterpretation of the information because it can lead to further unrealistic dealings which will
not only demean the profession of an individual but also it will affect an organization or a health

Running Head: Euthanasia Ethical Issues in Ontario Canada. 9
facility where the act is reported from (Springer, Jenner, Tichy & Grimm, 2019). Confidentiality
therefore is important in euthanasia cases since it helps to uphold the reputation of the health
facility as well as that of the medics whom each and every person trusts with their delicate
information.
Integrity and professional values
At all moments during interaction with individuals and patients of different calibers, medical
practitioners are expected to uphold integrity. Integrity in the medical profession is highly
guarded and should never be compromised (Brouwer, Kaczor, Battin, Maeckelberghe, Lantos, &
Verhagen, 2018). This is because almost every person has some information in a hospital
somewhere. In Ontario integral principles of social justice are hooked into integrity and nuring
policies in a bid to ensure integrity of the nurses and other medics is not compromised whatever
the case. The values learned in the nursing profession should therefore be projected to the larger
community so as to ensure maximum trust is gained for continuous support of the people and all
the community stakeholders (Math & Chaturvedi, 2015). This should therefore be projected even at
the instances where euthanasia is being practiced for the well being of the patient. All medical
activities from the smallest to the major should be handled with a lot of integrity so as to retain
the reputation.
Conclusion
Euthanasia is the process where patients who have no signs of recovery are assisted to die. The
wish of the patient as well as the level or extent of pain the patient is undergoing are the main
aspects considered before the action is undertaken. Among the ethical issues surrounding the

Running Head: Euthanasia Ethical Issues in Ontario Canada. 10
whole issue of euthanasia are autonomy, integrity, compassion, respect confidentiality
beneficence, nonmalefecence, professionalism and justice which are all paid attention to in a bid
to ensure the well being of the patient as well as that of the relevant care providers are put into
consideration. Compromise of the medics is not supported around the issue of euthanasia.

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References
Brouwer, M., Kaczor, C., Battin, M. P., Maeckelberghe, E., Lantos, J. D., & Verhagen, E.
(2018). Should Pediatric Euthanasia be Legalized? Pediatrics, 141(2), 1–5.
https://doi.org/10.1542/peds.2017-1343
Caputo, A. (2015). Trends of psychology-related research on euthanasia: a qualitative software-
based thematic analysis of journal abstracts. Psychology, Health & Medicine, 20(7), 858–
869. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=s3h&AN=108741269&site=ehost-live
Caron, J.-F. (2014). An Ethical and Judicial Framework for Mercy Killing on the Battlefield.
Journal of Military Ethics, 13(3), 228–239.
https://doi.org/10.1080/15027570.2014.975008
Cuman, G., & Gastmans, C. (2017). Minors and euthanasia: a systematic review of argument-
based ethics literature. European Journal of Pediatrics, 176(7), 837–847.
https://doi.org/10.1007/s00431-017-2934-8
De Bal, N., De Casterlé, B. D., & Gastmans, C. (2017). Nurse Involvement in the Care for Patients
Requesting Euthanasia. At the Interface / Probing the Boundaries, 58, 73–96. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ufh&AN=58843740&site=ehost-live
Forbes, S. (2018). Time to Terminate: “Assisted Dying.” Forbes, 201(7), 17. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=buh&AN=131523200&site=ehost-live

Running Head: Euthanasia Ethical Issues in Ontario Canada. 12
Goldstein, N. E., Cohen, L. M., Arnold, R. M., Goy, E., Arons, S., & Ganzini, L. (2016). Prevalence of
Formal Accusations of Murder and Euthanasia against Physicians. Journal of Palliative
Medicine, 15(3), 334–339. https://doi.org/10.1089/jpm.2011.0234
Hosseinzadeh, K., & Rafiei, H. (2019). Nursing Student Attitudes toward Euthanasia: A Cross-
Sectional Study. Nursing Ethics, 26(2), 496–503.
https://doi.org/10.1177/0969733017718393
Keown, J. (2016). Voluntary Euthanasia and Physicianassisted Suicide: Should the WMA Drop
its Opposition? World Medical Journal, 62(3), 103–107. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=119438775&site=ehost-live
Maria Therese A., Rukumani J., Mano, P. P., Ponrani, & Nirmala. (2014). A Study to Assess the
Level of Attitude Towards Euthanasia among Health Personnel. Nitte University Journal
of Health Science, 4(4), 18–22. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=108726309&site=ehost-live
Math, S. B., & Chaturvedi, S. K. (2015). Euthanasia: Right to life vs right to die. Indian Journal of
Medical Research, 136(6), 899–902. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=87632453&site=ehost-live
Minerva, F., & Sandberg, A. (2017). Euthanasia and cryothanasia. Bioethics, 31(7), 526–533.
https://doi.org/10.1111/bioe.12368
Muller, M. T., Kimsma, G. K., & van der Wal, G. (2018). Euthanasia and Assisted Suicide: Facts,
Figures and Fancies with Special Regard to Old Age. Drugs & Aging, 13(3), 185–191.
https://doi.org/10.2165/00002512-199813030-00001
Requena, P. (2016). Why Should the World Medical Association not Change its Policy towards
Euthanasia? World Medical Journal, 62(3), 99–103. Retrieved from

Running Head: Euthanasia Ethical Issues in Ontario Canada. 13
http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=119438774&site=ehost-live
Ricou, M., & Wainwright, T. (2018). The psychology of euthanasia: Why there are no easy
answers. European Psychologist. https://doi.org/10.1027/1016-9040/a000331
Shekhawat, R. S., Kanchan, T., Setia, P., Atreya, A., & Krishan, K. (2018). Euthanasia: Global
Scenario and Its Status in India. Science & Engineering Ethics, 24(2), 349–360.
https://doi.org/10.1007/s11948-017-9946-7
Shibata, B. (2017). An Ethical Analysis of Euthanasia and Physician-Assisted Suicide: Rejecting
Euthanasia and Accepting Physician Assisted Suicide with Palliative Care. Journal of
Legal Medicine, 37(1/2), 155–166. https://doi.org/10.1080/01947648.2017.1303354
Springer, S., Jenner, F., Tichy, A., & Grimm, H. (2019). Austrian Veterinarians’ Attitudes to
Euthanasia in Equine Practice. Animals (2076-2615), 9(2), 44.
https://doi.org/10.3390/ani9020044
Sullivan, M. (2019). Ethics of Assisted Suicide and Euthanasia. Nursing Management, 30(3),
31–33. https://doi.org/10.1097/00006247-199903000-00011
Weikart, R. (2016). Does Science Sanction Euthanasia or Physician-Assisted Suicide? Human
Life Review, 42(2), 30–36. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=116144396&site=ehost-live